Five cases of measles confirmed in the greater Houston area

1of12FILE - A vial containing the measles vaccine is loaded into a syringe before being given to a baby in Los Angeles, Calif. on Feb. 6, 2015. Monday, officials announced three cases of the measles virus in Harris County, Texas and advised residents to be current on their vaccinations.Photo: Mel Melcon, FILE / TNS

2of12PHOTOS: Schools with the highest percentage of vaccine exemptionsSeveral schools in Harris County reported that more than 10 percent of its student population declined vaccinations for personal reasons during the 2017-18 school year.Photo: Toby Talbot, STF / AP

Five cases of measles have been confirmed in the greater Houston area, a regional cluster that makes Texas the eleventh state this year to report the highly contagious disease until recently thought virtually eliminated in the U.S.

The cases, all announced Monday, include three in Harris County, one in Galveston County and one in Montgomery County. They involve four children, all under 2 years of age, and a woman between the ages of 25 and 35. All are doing well now.

"This is a reminder for people to be on guard and be up to date on their vaccinations," said Dr. Umair A. Shah, executive director for Harris County Public Health. "Measles, a serious disease, is in our community."

Measles, caused by an airborne virus, is particularly dangerous, capable of causing serious neurological disorders and death in infants and the developing fetus in pregnant women. It is spread through direct contact with discharge through the nose and mouth as well as coughing and sneezing.

Shah said it was too early to say whether the five cases might be the start of a local outbreak. The counties are monitoring anyone exposed to the measles patients while they were contagious to see if they develop symptoms. None has so far.

Dr. Peter Hotez, an infectious disease specialist at Baylor College of Medicine and Texas Children's Hospital, said he's concerned because in the pre-vaccine era, measles typically peaked in the late winner and early spring. He said "a perfect storm could be coming."

The numbers have already begun increasing in Texas. There was one case per year in the state in each of 2015, 2016 and 2017, then nine cases last year. This year's possible sixth case, elsewhere in Texas, awaits lab testing, said a spokesman for the state department of health.

The local cases occurred independently of each other except for the Harris County woman and the Montgomery County child, a girl. Health officials said there was a connection between the two cases but provided no details.

Hotez said the fact that the other three cases, all involving boys, were unrelated suggests there may have been multiple original sources. Shah noted that Harris County's original source or sources, known in public health circles as Patient Zero, is unknown.

The cases come amid a resurgence of measles, often linked to people not being vaccinated. The largest recent outbreak, at least 209 cases since October, has occurred in New York and New Jersey since last fall, an outbreak linked to unvaccinated children's travel to Israel. In all in Europe, there were nearly 60,000 cases last year.

There have also been 49 cases reported since late last year in the state of Washington, which has declared a state of emergency. A vast majority of those weren't vaccinated against the disease, health officials there report.

It was unclear Monday if a lack of vaccination played a role in any of the Houston-area cases. All four children had received the first of the two shots — the second is given between the ages of 4 and 6 — and the woman said she'd been vaccinated, though the county is still working to confirm that through records.

Shah noted that the first dose of the MMR (measles, mumps and rubella) vaccine is fully protective in 85 percent of those who get it, but there's no way of knowing if a child is in that group or the 15 percent who need the second shot to receive full protection.

Shah also noted that the person or persons who originally transmitted the virus may have been unvaccinated, he said.

"2019 might be the year we really see the public health consequences of anti-vaxxers," said Hotez, who's waged a campaign against the movement the last two years. "In a sense, we already saw that in 2018, but it looks like cases may pick up more in 2019."

A 2018 study led by Hotez found four Texas counties, including Harris County, ranked in the top 15 metropolitan "hot spots" of vaccine exemptions, the nation's areas with the highest numbers of kindergartners not getting inoculated for nonmedical reasons. Throughout the state, those numbers have spiked from less than 3,000 in 2003 to about 50,000 in 2017, the latest year for which statistics are available.

There are no current measles cases in Houston. The last confirmed report of measles in Houston was last year, a case imported from overseas that received attention after a Texas Children's nurse posted about it on a Facebook page called Proud Parents of Unvaccinated Children. Before that, the last case in Houston was 2013.

The current cases in Harris County are in the northwest area.

Houston's MMR (measles, mumps and rubella) vaccination rate for children under 2 is 87.8 percent, below the national rate of 91.5 percent and the Texas rate of 90.3 percent.

About 1 of 4 who get measles will be hospitalized — two of the five local people were — and nine of 10 people around someone showing symptoms will become infected if they're not vaccinated.

Common symptoms include fever, a runny nose, a hacking cough, red eyes with severe sensitivity to light and a distinctive rash. The vaccine's first dose is not given until 12 to 15 months of age.

Other states that have reported measles cases this year are Hawaii, Oregon, Pennsylvania, Connecticut, Colorado, California and Georgia.

todd.ackerman@chron.com

NOTE: This story has been updated to reflect the latest MMR vaccination rates.

Todd Ackerman is a veteran reporter who has covered medicine for the Houston Chronicle since 2001. A graduate of the University of California at Los Angeles, he previously worked for the Raleigh News & Observer, the National Catholic Register, the Los Angeles Downtown News and the San Clemente Sun-Post.